Smoking is the single most preventable cause of morbidity and mortality, accountable for 438,000, or one out of every five, fatalities in the United States annually. Smoking harms almost every organ in the body, leading to a multitude of diseases and a general decline in health. Unfortunately, individuals from low income populations have higher rates of tobacco use and lower rates of tobacco cessation. In fact, approximately 30.6 percent of U.S. adults living below the federal poverty level are current smokers compared to 20.4 percent of adults living above this level. People with disabilities (PWD) very often fall into this low income category. Data from the U.S. Census Bureau show that PWD receive less education, rely more on state/federal assistance, have government issued health insurance, and are more likely to live below the national poverty level. Moreover, 76.6% of PWD compared to 39.3% of people without disabilities reported earning less than $20,000 per year. Approximately 50 million Americans (22%) suffer from some form of disability, with evidence suggesting that smoking rates within the disabled community are double that of the general population. Additionally, PWD are more likely to have ever smoked and be current smokers, had fewer quit attempts, smoked more cigarettes per day, and smoked earlier upon waking. The higher incidence of tobacco use among PWD has been shown to be directly related to barriers to tobacco cessation treatment which include: attitudinal barriers by health professionals leading to less dissemination of tobacco cessation materials, accessibility to preventative health care, and economic disparity. The purpose of this proposal is to develop a tobacco cessation program designed by and for PWD. According to NIH, limited available research data regarding tobacco interventions suggest that both adapting general treatment methods and developing novel approaches may be effective in developing cessation programs for low-income populations. Additionally, interventions for unique populations, including PWD, are most promising for health behavior change when they included feedback from the targeted communities. Therefore, we are proposing to conduct Community-Based Participatory Research (CBPR) to develop and test a tobacco cessation group treatment program for PWD. Consumers with disabilities who use tobacco will be recruited from a large population of PWD utilizing services at multiple centers for independent living (CIL) within North Central Florida. CILs provide immediate and long- term solutions for people with disabilities through assistance with finding housing or a job, equipping a home with assistive technologies, and enhancing independent living skills. Strong preliminary data collected by our research team suggests that tobacco cessation represents a high priority among CILs. Since this R21 is designed for novel, exploratory, and pilot studies, this project will lead to a process-evaluated tobacco cessation program for PWD. Study findings will set the stage for a subsequent controlled clinical trial examining the efficacy of a CBPR-based tobacco treatment program for this low income population. . PUBLIC HEALTH RELEVANCE: The proposed study is innovative primarily because it will be the first study involving the use of CBPR to develop a tobacco cessation group counseling program specific for people with disabilities. Additionally, this study serves as an ideal community-based research model for addressing major public health issues for people with disabilities. Finally, this project will make increased advancement towards engaging PWD in the full research process and which will serve as a model for future work on many important public health needs of this special population.